- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.07 / $32.07 / $32.07
| Professional | | $32.07 | $32.07 | $32.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.94 / $170.94 / $170.94
| Facility | | $170.94 | $170.94 | $170.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.37 / $81.37 / $236.71
| Professional | | $81.37 | $81.37 | $236.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.19 / $225.33 / $225.33
| Professional | | $215.19 | $225.33 | $225.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.11 / $215.19 / $301.27
| Professional | | $129.11 | $215.19 | $301.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.93 / $170.94 / $236.71
| Professional | | $71.93 | $170.94 | $236.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.11 / $173.34 / $204.82
| Professional | | $94.11 | $173.34 | $204.82 |